Objective: This study aimed to describe the development and evaluation of an OA eLearning program for healthcare professionals. The evaluation objectives were to measure the usability of, and engagement with, this program and assess the perceived feasibility, acceptability, appropriateness and user satisfaction among OA healthcare professionals. Methods: A feasibility study was conducted, involving registered healthcare professionals, who regularly manage people with OA. Following baseline questionnaires, participants were asked to complete at least four OA eLearning modules over 10 weeks, followed by a 23-item evaluation questionnaire. The primary outcomes were usability and engagement with the OA eLearning program. Secondary outcomes included feasibility, acceptability, appropriateness, and satisfaction. Results: The 31 eligible participants reflected a broad range of professional experiences, nationalities and settings. Program usability, engagement with content, navigation, presentation and overall satisfaction were rated as either very good or good by at least 84% of participants. Participants considered the program to be acceptable, feasible, and appropriate, with some areas for improvement in navigating the program. Conclusions: The OA eLearning program shows promise in supporting healthcare professionals to deliver evidence-based care. While the findings from this study will inform a randomised trial, the OA eLearning program is well positioned to enhance clinical education and practice.

ABSTRACT This study aimed to compare the accuracy of machine learning classification for three commonly prescribed shoulder exercises in people with and without rotator cuff tendinopathy. Eighteen participants with rotator cuff tendinopathy (mean age 54.2, SD 13.2; 50% female), followed by eighteen matched controls completed a laboratory‐based shoulder strength testing protocol. Three exercises were performed (shoulder press, lateral raise and bent over row) while wearing three inertial measurement (IMU) sensors (Axivity, Ax6 ‐ 3 axis accelerometry and gyroscope at 100 Hz and 1000°/sec respectively) positioned on the wrist arm and trunk. Data were analysed and accuracy was compared between common machine learning algorithms for those with rotator cuff tendinopathy and healthy matched controls in a subject‐dependent and subject‐independent model. The best accuracy scores for the subject‐dependent results were achieved by a random forest algorithm; 96.12% (3‐sensor combined system) for those with rotator cuff tendinopathy. For the subject‐independent results best accuracy scores were achieved by a convolutional neural network algorithm; 94.55% (3‐sensors) for the healthy controls without shoulder pain. K‐fold cross validation confusion matrix results by exercise type for the entire cohort show 97% accuracy (shoulder press), 95.5% (lateral raise) and 90.7% (bent over row) (3‐sensors, CNN subject‐independent analysis). Machine learning classification of 3 different shoulder exercises in people with rotator cuff tendinopathy and matched healthy controls demonstrate most accurate results using a CNN algorithm for subject‐independent analysis and a RF algorithm for subject‐dependent analysis. Results were similar for both those with rotator cuff tendinopathy and their matched healthy controls.

Objective:Exercise is fundamental to osteoarthritis (OA) management, but access to in-person programs is often limited. Remotely-delivered exercise services (RDES) present a viable alternative; however, their acceptability among patients in Hong Kong (HK) is not well established. This study sought to investigate patient perceptions, compare them with existing Australian data, and inform the development of culturally tailored OA care in urban Asian settings. Design:A cross-sectional study was conducted using online surveys completed by 243 OA patients in HK. Participants rated their perceptions on 5-point Likert scales. Descriptive analysis was conducted and results were visualized using radar charts, and findings were compared with one published Australian study. Results:Although 70% of HK patients expressed interest in RDES, valuing time-saving (79%) and convenience (67%), significant concerns persisted. Only 34% found RDES affordable, and merely 40% believed it offered satisfaction equivalent to in-person care. Furthermore, HK patients reported lower agreement than Australians on satisfaction (40% vs 68%) and ease of use (51% vs 78%). Conclusion:Hong Kong OA patients recognize the potential benefits of RDES, yet key concerns regarding affordability, satisfaction, and effectiveness remain. The discrepancies with both local clinicians and international benchmarks highlight a critical implementation gap. These findings emphasize the necessity for co-designed, culturally adapted interventions to successfully integrate RDES into OA care in Hong Kong.

BACKGROUND:Although X-rays are not recommended for routine diagnosis of osteoarthritis (OA), clinicians and patients often use or expect X-rays. We evaluated whether: (i) a radiographic diagnosis and explanation of knee OA influences patient beliefs about management, compared to a clinical diagnosis and explanation that does not involve X-rays; and (ii) showing the patient their X-ray images when explaining radiographic report findings influences beliefs, compared to not showing X-ray images. METHODS AND FINDINGS:This was a 3-arm randomised controlled trial conducted between May 23, 2024 and May 28, 2024 as a single exposure (no follow-up) online survey. A total of 617 people aged ≥45 years, with and without chronic knee pain, were recruited from the Australian-wide community. Participants were presented with a hypothetical scenario where their knee was painful for 6 months and they had made an appointment with a general practitioner (primary care physician). Participants were randomly allocated to one of 3 groups where they watched a 2-min video of the general practitioner providing them with either: (i) clinical explanation of knee OA (no X-rays); (ii) radiographic explanation (not showing X-ray images); or (iii) radiographic explanation (showing X-ray images). Primary comparisons were: (i) clinical explanation (no X-rays) versus radiographic explanation (showing X-ray images); and (ii) radiographic explanation (not showing X-ray images) versus radiographic explanation (showing X-ray images). Primary outcomes were perceived (i) necessity of joint replacement surgery; and (ii) helpfulness of exercise and physical activity, both measured on 11-point numeric rating scales (NRS) ranging 0 to 10. Compared to clinical explanation (no X-rays), those who received radiographic explanation (showing X-ray images) believed surgery was more necessary (mean 3.3 [standard deviation: 2.7] versus 4.5 [2.7], respectively; mean difference 1.1 [Bonferroni-adjusted 95% confidence interval: 0.5, 1.8]), but there were no differences in beliefs about the helpfulness of exercise and physical activity (mean 7.9 [standard deviation: 1.9] versus 7.5 [2.2], respectively; mean difference -0.4 [Bonferroni-adjusted 95% confidence interval: -0.9, 0.1]). There were no differences in beliefs between radiographic explanation with and without showing X-ray images (for beliefs about necessity of surgery: mean 4.5 [standard deviation: 2.7] versus 3.9 [2.6], respectively; mean difference 0.5 [Bonferroni-adjusted 95% confidence interval: -0.1, 1.2]; for beliefs about helpfulness of exercise and physical activity: mean 7.5 [standard deviation: 2.2] versus 7.7 [2.0], respectively; mean difference -0.2 [Bonferroni-adjusted 95% confidence interval: -0.7, 0.3]). Limitations of our study included the fact that participants were responding to a hypothetical scenario, and so findings may not necessarily translate to real-world clinical situations, and that it is unclear whether effects would impact subsequent OA management behaviours. CONCLUSIONS:An X-ray-based diagnosis and explanation of knee OA may have potentially undesirable effects on people's beliefs about management. TRIAL REGISTRATION:ACTRN12624000622505.

There is limited evidence on the comparative effectiveness of different exercise modalities, such as yoga and strengthening exercises, for managing knee osteoarthritis (OA). To compare the effectiveness of yoga vs strengthening exercise for reducing knee pain over 12 weeks in patients with knee OA. This single-center, assessor-blinded (for nonpatient-reported outcomes), parallel-arm, active-controlled, superiority randomized clinical trial included adults aged 40 years or older with knee OA and knee pain levels of 40 or higher on a 100-mm visual analog scale (VAS) in Southern Tasmania, Australia. Participants were recruited from April 2021 to June 2022, and follow-up was completed in December 2022. Data were analyzed from May 2023 to July 2024. Participants were randomized 1:1 to the yoga and strengthening exercise groups. Both groups attended 2 supervised and 1 home-based session per week for 12 weeks followed by 3 unsupervised home-based sessions per week for weeks 13 to 24. The primary outcome was the between-group difference in VAS score over 12 weeks assessed using a range of 0 (no pain) to 100 (worst possible pain) with a prespecified noninferiority margin of 10 mm. Secondary outcomes included knee pain over 24 weeks; Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain, function, and stiffness; patient global assessment; Osteoarthritis Research Society International–Outcome Measures in Rheumatology Clinical Trials response; physical performance measures; leg muscle strength; health-related quality of life assessed via the Assessment of Quality of Life–8 Dimensions (AQol-8D) utility score; depression assessed with the Patient Health Questionnaire–9; and neuropathic pain assessment over 12 and 24 weeks. Analyses were based on the intention-to-treat principle. In total, 117 participants were randomized to the yoga (n = 58) or strengthening exercise (n = 59) program. Baseline characteristics of the participants were similar, with a mean (SD) age of 62.5 (8.3) years, and 85 participants (72.6%) were female. The mean (SD) baseline VAS knee pain score of 53.8 (16.0) indicated moderate knee pain. Over 12 weeks, the between-group mean difference in VAS knee pain change was −1.1 mm (95% CI, −7.8 to 5.7 mm), which was not statistically significant but remained within the prespecified noninferiority margin. Of 27 secondary outcomes assessed over 12 and 24 weeks, 7 were statistically significant in favor of yoga. The yoga group showed modestly greater improvements than the strengthening exercise group (between-group differences) over 24 weeks for WOMAC pain (−44.5 mm [95% CI, −70.7 to −18.3 mm]), WOMAC function (−139 mm [95% CI, −228.3 to −49.7 mm]), WOMAC stiffness (−17.6 mm [95% CI, −30.9 to −4.3 mm]), patient global assessment (−7.6 mm [95% CI, −15.1 to −0.2 mm]), and 40-m fast-paced walk test (1.8 [95% CI, 0.4-3.2]). In addition, the yoga group had a modestly greater improvement than the strengthening exercise for depression at 12 weeks (between-group difference in PHQ-9 score, −1.1 [95% CI, −1.9 to −0.2]) and quality of life at 24 weeks (between-group difference in AQoL-8D score, 0.04 [95% CI, 0.0 to 0.07]). Adverse events were similar in both groups and mild. In this randomized clinical trial, yoga did not significantly reduce knee pain compared with strengthening exercises. However, yoga was found to be noninferior to strengthening exercises, suggesting that integrating yoga as an alternative or complementary exercise option in clinical practice may help in managing knee OA. ANZCTR.org Identifier: ACTRN12621000066886.